'Boiled Egg' in the Peritoneal Cavity-a Giant Peritoneal Loose Body in a 64-year-old Man

A Case Report

Ajit Sewkani; Aruna Jain; KK Maudar; Subodh Varshney

Disclosures

J Med Case Reports. 2011;5(297) 

In This Article

Abstract and Introduction

Abstract

Introduction: Peritoneal loose bodies, or peritoneal mice, are rare asymptomatic lesions that are usually found as an incidental finding during abdominal surgery or autopsy. Giant loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. These bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity. They may re-attach themselves to a surface, such as the lower aspect of the spleen or omentum, in which case they can be called a "parasitized peritoneal body", as in our case.
Case Presentation: We report a case of a giant loose peritoneal body measuring 7 × 5 cm found incidentally in a 64-year-old Indian man who presented with acute intestinal obstruction. We present the current hypothesis and our opinion on the genesis of such large bodies and discuss the problems in diagnosis.
Conclusion: Peritoneal loose bodies are common but giant peritoneal loose bodies are very rare. These giant bodies usually do not require any treatment until they become complicated. Present diagnosis modalities have limitations in the diagnosis of mobile lesions in the abdominal cavity, so care must be taken to avoid unnecessary laparotomies in uncomplicated cases.

Introduction

Peritoneal loose bodies are rare and found incidentally at laparotomy. In most cases they are small in size (usually less than 1 cm). Giant loose bodies (more than 5 cm) are very rare and only a few cases have been reported in the literature.[1–10] Its exact pathogenesis is not known but the most common origin of these bodies are appendices epiploicae (by the sequential process of torsion, infarction, saponification and calcification).[1,2]

These loose bodies are usually incidental findings that do not require any specific treatment until they become complicated.[3–6] Generally, computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosis of these lesions; however present literature shows the limitation in the diagnosis of movable masses by CT and MRI.[2,7] We report a case of a giant loose peritoneal body with special reference to the genesis of such large bodies and also discuss the problems in diagnosis.

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